Eating Disorders And Pcos During The Lockdown

By Dr. Shraddha Murali, Post-Intern (MBBS, KMC Manipal) 

Prithvi Sanjeevkumar Gaur, 4th MBBS (SKNMC, Pune)

COVID-19 brought with it an upheaval in the lives and subsequently, the lifestyles of the human race. Social interactions among humans diminished due to the multiple lockdowns proclaimed all over the country. There was a swift switch to a work-from-home culture and online schooling. This inevitably led to humans leading more sedentary lives, which in turn brought with it a new set of health challenges.

Polycystic ovarian syndrome (PCOS) is a common endocrine disorder among women of the reproductive age group with its prevalence ranging from 3.7% to 22.5% in India and approximately 9.13% in female adolescents in India.^1-2 The pandemic and subsequent lockdowns have witnessed a worrying increase in the incidence of PCOS cases across the country, making it a major cause of concern. The disorder is not only associated with menstrual irregularities, metabolic disturbances, and infertility, but the aforementioned metabolic disturbances significantly increase the risk for COVID-19, its complications, and a worse outcome.³

Evidence shows that the pandemic also saw a rise in the incidence or worsening of restrictive eating disorders (EDs) among the adolescent age group and other EDs like anorexia nervosa, bulimia nervosa, and binge eating disorder.^4,5 Discussions at the International Conference on Eating Disorders reported a spike in EDs and people seeking medical help for the same.⁶ First-hand accounts from across the globe reveal that most people started with healthy goals by eating healthier and exercising more. However, it would soon take a serious turn with parents noticing excessive weight loss in the kids. EDs were predominantly seen in association with low self-esteem, depressive symptoms, and sudden change in the day-to-day life of these adolescents.^5,7,8 Contrarily, the lack of routine, fixed mealtimes (working from home often leads to people grabbing multiple quick meals at any available time), and an inability to go regularly for grocery shopping, resulting in stockpiling and consequently, excessive consumption of snack foods indicate bulimic tendencies.⁹

  The development of EDs has particularly greater consequences in women suffering from PCOS. These women characteristically suffer from irregular menstrual cycles, androgen excess, and polycystic ovaries.¹⁰ They may also be seen to suffer from insulin resistance which leads to an increase in insulin levels in the body and consequently leads to an increase in body weight.¹¹ Their inability to sleep well and the apparent rise in anxiety levels during the pandemic have left the patients suffering from PCOS at a higher risk of developing EDs and its consequences. 

Patients of PCOS are advised a eucaloric Low CHO diet, relatively low in carbohydrate (43%) and cholesterol, high in fiber, and 45% fat (18% monounsaturated fat and <8% saturated fat), which is seen to improve their metabolic profile within 16 days.¹² Thus, it is imperative to allow for the switch from excessive stress-eating seen predominantly during the pandemic to a healthy balanced diet accompanied with home workouts to prevent unhealthy consequences of EDs in patients of PCOS. Dieticians and nutritionists advise the intake of raw bananas, yams, and sprouted legumes to reduce symptoms of pre-menstrual stress and weight training and yoga to provide relief from menstrual cramps. Intake of ghee, jaggery along with calcium and vitamin B12 supplementation can also help with PCOS symptoms. 

The dietary patterns in patients with PCOS are an important determinant of their health and need to be kept a closer eye on, especially during the pandemic. It is important that adolescents are given regular attention to ensure that they maintain a positive body image, as a lack of the same can have adverse effects on both their physical and mental health.

References

1. Ganie MA, Vasudevan V, Wani IA, Baba MS, Arif T, Rashid A. Epidemiology, pathogenesis, genetics & management of polycystic ovary syndrome in India. Indian J Med Res. 2019 Oct;150(4):333–44. 
2. Nidhi R, Padmalatha V, Nagarathna R, Amritanshu R. Prevalence of polycystic ovarian syndrome in Indian adolescents. J Pediatr Adolesc Gynecol. 2011 Aug;24(4):223–7. 
3. Kyrou, I., Karteris, E., Robbins, T. et al. Polycystic ovary syndrome (PCOS) and COVID-19: an overlooked female patient population at potentially higher risk during the COVID-19 pandemic. BMC Med 18, 220 (2020).

4. Shah M, Sachdeva M, Johnston H. Eating disorders in the age of COVID-19. Psychiatry Res. 2020 Aug;290:113122. 
5. Otto AK, Jary JM, Sturza J, Miller CA, Prohaska N, Bravender T, et al. Medical Admissions Among Adolescents With Eating Disorders During the COVID-19 Pandemic. Pediatrics. 2021 Jul 8;e2021052201. 
6. Feinmann J. Eating disorders during the covid-19 pandemic. BMJ. 2021 Jul 19;374:n1787. 
7. Rodgers RF, Slater A, Gordon CS, McLean SA, Jarman HK, Paxton SJ. A Biopsychosocial Model of Social Media Use and Body Image Concerns, Disordered Eating, and Muscle-Building Behaviors among Adolescent Girls and Boys. J Youth Adolesc. 2020 Feb;49(2):399–409. 
8. Effects of acute and chronic sleep deprivation on eating behaviour – Lombardo – 2020 – Clinical Psychologist – Wiley Online Library [Internet]. [cited 2021 Sep 15]. Available from: https://aps.onlinelibrary.wiley.com/doi/abs/10.1111/cp.12189
9. Solmi F, Downs JL, Nicholls DE. COVID-19 and eating disorders in young people. The Lancet Child & Adolescent Health. 2021 May 1;5(5):316–8. 
10. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004 Jan;81(1):19–25. 
11. Krug I, Giles S, Paganini C. Binge eating in patients with polycystic ovary syndrome: prevalence, causes, and management strategies. Neuropsychiatr Dis Treat. 2019 May 16;15:1273–85. 
12. Douglas CC, Gower BA, Darnell BE, Ovalle F, Oster RA, Azziz R. Role of diet in the treatment of polycystic ovary syndrome. Fertil Steril. 2006 Mar;85(3):679–88.

https://www.ncbi.nlm.nih.gov/books/NBK525302/